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Background
A century of research has sought to explain the socio-economic gradient
in men's health. However, studies conducted over the last decade
have shown that the socio-economic gradients in women's health are
similar to those found among men only when women's socio-economic
status is measured by the occupation of male partners. When women's
own occupations are used, the gradient becomes less pronounced.
For some dimensions of women's health, like breast cancer, there
is no clear-cut socio-economic gradient.
However, classifying women by their own occupation is not without
problems. This is partly because of the high proportion of women
who work part-time or are not in paid employment. It is also because
the conventional socio-economic classification, based on the social
ordering of male occupations at the turn of the century, does not
capture the occupational structures which characterise women's employment.
The project
tackles the barriers to analysing the socio-economic gradients in
women's health. It does so by using two alternative indicators of
socio-economic position. The Erickson-Goldthorpe (E-G) schema is
a measure of employment conditions and measures the degree to which
an individual controls her own work schedule and has job security
and a career structure. The Cambridge scale is a measure of lifestyle
advantage. It is derived from a factor-analysis of the occupations
of an individual's closest friends and reflects the social choices
people make about their way of life.
Aims and
Objectives
The aim of the study is to examine the socio-economic variations
in health-related behaviour, in ill-health and in mortality among
women, using the E-G schema and the Cambridge scale. Cardiovascular
morbidity is the selected dimension of ill-health, one of the most
prevalent chronic diseases in women and a major cause of mortality.
The objectives
of the study are to examine:
- the associations
between health-related behaviour, ill-health, mortality and employment
conditions (E-G schema);
- the associations
between health-related behaviour, ill-health, mortality and life-style
advantage (Cambridge scale);
- the similarities
and differences in the patterns uncovered using the two measures;
- the influence
on these associations of women's labour market position, the social
position of their partners and the material conditions of the
household.
Study Design
The project is based on secondary data analysis of three large data
sets: the Health and Lifestyle Survey (HALS), the Health Survey
for England (HSFE) and the Office for National Statistics Longitudinal
Study (ONS-LS). All participants in these three studies are allocated
a Standard Occupational Code, which makes it possible to classify
them into the E-G schema and the Cambridge scale. The association
between these two measures and cardiovascular morbidity and risk
factors (smoking, diet, exercise, blood pressure) will be tested
in the HALS and HSFE, and the association between these two measures
and mortality will be tested using the ONS-LS. Multivariate methods
will be used as appropriate. Methodological work on better ways
to compare the size of socio-economic differences forms an integral
part of the project.
Policy Implications
The study will contribute to comparative policy analysis, by developing
measures of women's socio-economic status which can be applied in
countries outside the UK. Because the E-G schema was designed for
comparative analysis, the study will make it possible to compare
social variations in women's health between nations and illuminate
the effects of employment patterns and social policies on health
variations.
The study will
also enhance the knowledge-base of British policy and practice.
It will identify the relative importance of employment conditions
and lifestyle advantage on the health-related behaviour, ill-health
and mortality of women. An assessment of the relationship between
general social advantage and employment conditions on the one hand,
and cardiovascular morbidity on the other, will also be valuable
in projecting future trends in the pattern of cardiovascular disease
and in the demand for health services.
Project Summary
Research on health inequalities has relied on studies of men
and on single measures of socio-economic position, like social class
based on occupation. This project sought to advance understanding
through analyses of women which captured the health effects of different
dimensions of socio-economic inequality. Inequality was conceptualised
as having three important dimensions: employment conditions (measured
by the Erikson-Goldthorpe schema), cultural and social advantage
(by the Cambridge scale) and material circumstances (measured by
housing tenure and car ownership). The project investigated how
these dimensions of women's socio-economic position related to risk
factors for cardiovascular disease (diet, smoking, drinking, sport
participation, hypertension, obesity, breathlessness, social support
and work control and variety) and to health. It used the Health
Survey for England, the Health and Lifestyle Survey and the Office
for National Statistics-Longitudinal Study (ONS-LS). During the
lifetime of the project, the new ONS Socio-economic Classification
(SEC) was introduced, a theoretically-derived classification designed
to capture differences in autonomy, security and career structure
provided by different occupations. The team extended their research
to include this new schema.
Key findings
- Inequalities
in women's self-rated health, a powerful predictor of mortality,
are revealed using both the Erikson-Goldthorpe schema (E-G schema)
and the Cambridge scale, with stronger gradients for the measure
of social advantage. Whilst the health of women improved overall
between the 1980s and 1990s, the differences between women in
the least advantaged and most advantaged positions showed no signs
of narrowing and may have widened across this period.
- The strength
of the relationship between social position and cardiovascular
risk factors varies between different measures, with the measures
of social position related in different ways to different risk
factors for both men and women. This suggests that studies using
different socio-economic indicators to investigate the pathways
between social position and health may obtain contradictory results.
- In path analyses,
all three measures of social position affected health both independently
and via the risk factors, but the pathways of effect were not
the same. Different dimensions of inequality may operate through
different behavioural and psycho-social pathways. Material circumstances
had the greatest effect on health, followed by general social
advantage. The total effect of the material circumstances index
was over three times greater than the effect of the Cambridge
scale and over five times greater than that of the E-G schema.
- The effect
of social position on health was only partially mediated by recognised
risk factors for ill health: there were also direct pathways from
all three measures of social position to ill health. The effect
of material deprivation was explained least successfully by the
mediating variables.
- The pathways
between social position and ill health varied among women with
different degrees of attachment to the labour market. For women
at home without outside employment, the combination of social
advantage and material circumstances fully explained socio-economic
gradients in health and risk factors. For women in full-time work,
employment conditions made a major contribution to the socio-economic
gradient in ill health.
- Analyses
of inequalities in mortality among employed working age men and
women in the ONS-LS were undertaken using the Cambridge scale
(social advantage of the household) and the SEC (employment relations
of the individual). Social class based on employment relations
was the stronger predictor of mortality in men; among women, the
dominant factor was social advantage. As this suggests, a better
understanding of health inequality is possible when measures are
used which are sensitive to the multidimensional nature of social
inequality and the uneven effects of these dimensions on men and
women.
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